Psychosocial and Health Factors Increased Risk for Severe Depression During the COVID-19 Pandemic

Right now, the wellbeing among high-risk groups during the COVID-19 pandemic is an immediate research priority.

Adults in the United Kingdom with elevated psychosocial and health-related risk factors were associated with moderate or severe symptoms of depression during the coronavirus 2019 (COVID-19) pandemic. These findings, from an ongoing large panel study, were published in JAMA Network Open.

Adults in the UK were invited to participate between March 21 and May 4 2020 in a weekly online survey about their experiences during the COVID-19 pandemic. Participants were assessed by the 9-item Patient Health Questionnaire (PHQ-9), for preexisting physical health and psychosocial conditions, and for sociodemographic features.

Participants (N=51,417) were aged mean 48.8 (standard deviation [SD], 16.8) years, 51.1% were women, and 60.1% were employed. Preexisting conditions were reported by 38.2%, 19.9% had at least 1 mental health condition, 11.3% had experienced psychological or physical abuse, and 30.5% reported moderate to severe depression during the first assessment.

Respondents were stratified into low (60.0%), moderate (29.0%), and high (11.0%) depressive symptom groups. The trajectory of depressive symptoms decreased at the start of the lockdown period but began to rise during weeks 5 and 6.

After adjusting for sex, age, and symptoms of COVID-19, a low sociodemographic profile was associated with moderate (odds ratio [OR], 1.97; 95% CI, 1.87-2.08; P <.001) and high (OR, 5.22; 95% CI, 5.08-5.36; P <.001) depressive symptoms.

Minority respondents were significantly associated with the moderate depression group (OR, 1.21; 95% CI, 1.03-1.40; P =.04).

Severe symptoms of depression were over 2-fold higher among those who had experienced abuse (OR, 13.16; 95% CI, 12.95-13.37; P <.001) or who had low levels of social support (OR, 12.72; 95% CI, 12.57-12.86; P <.001).

Depressive symptoms were most pronounced among individuals with preexisting mental health conditions (moderate: OR, 4.24; 95% CI, 4.24-4.24; P <.001 and severe: OR, 12.99; 95% CI, 12.87-13.10; P <.001) or physical health conditions (moderate: OR, 1.89; 95% CI, 1.79-1.98; P <.001 and severe: OR, 3.41; 95% CI, 3.29-3.54; P <.001).

This study may include some selection bias, as the participants did not cover all of the United Kingdom. Also, individuals who were interested in the topic of mental health may have been more likely to participate.

The study authors concluded that certain groups of individuals were at increased risk for moderate or severe symptoms of depression during the COVID-19 pandemic. Mental health services should shift their targeting to individuals in high-risk groups.


Iob E, Frank P, Steptoe A, Fancourt D. Levels of severity of depressive symptoms among at-risk groups in the UK during the COVID-19 pandemic. JAMA Netw Open. 2020;3(10):e2026064. doi: 10.1001/jamanetworkopen.2020.26064.